Q: I have endometriosis and now after 5
years, I have IBS (Irritable Bowel Syndrome). The doctor said I have some endometriosis
on my bowel. How common is this for women?

-R.

Dr. Donnica: Endometriosis is relatively common, but commonly misunderstood.
It affects one in 15 women, or 5 million Americans! Four in 10 of these
women will have infertility as a result. While endometriosis is marked
by severe cramping before and during menses, some women don't experience any
symptoms. In most cases, women are not affected until they reach their twenties
or thirties.

What causes endometriosis? Simply put, some of the lining cells of the
womb flow backward into the pelvis and implant on other tissues, such as the
ovaries or fallopian tubes. Being estrogen sensitive, these implants react
cyclically. They can grow and cause pain, abnormal bleeding, and tubal blockage.
There are many things we still don't understand about endometriosis: what causes
it, why the symptoms are not necessarily related to the size or location of
the implants, or what can be done to prevent it.

Endometriosis is also difficult to diagnose conclusively without a surgical
procedure called a laparoscopy. A laparoscopy allows your doctor to look
into your abdomen and pelvis with a lit tube through a small incision beneath
your belly button.

The key to diagnosing Irritable Bowel Syndrome (IBS) is a taking a thorough
patient history focused on characteristic bowel patterns, time and character
of pain, and exclusion of other diseases through physical examination and routine
diagnostic tests.

IBS is even more common than endometriosis, but they have many features in
common, including being commonly misdiagnosed. IBS is a relatively common syndrome
of abdominal discomfort or pain, bloating and changes in bowel habits (constipation
and/or diarrhea). The pain or cramping can be a dull ache over one or several
areas of the abdomen. For some women, it can be intolerable and without
relief.

Up to 20 percent of all U.S. adults are affected by IBS, which involves an
abnormality of the muscular action that passes food along the colon, as well
as an increased sensitivity of the nerves in the colon. IBS generally first
appears in a person's 20s to 40s and women are roughly three times more likely
than men to be affected. Women with IBS seem to have more symptoms during their
periods, suggesting that reproductive hormones may play a role. IBS has other
symptoms as well: constant fatigue or feeling tired, and even depression.

Because IBS and endometriosis are both marked by varying degrees of pain "down
there," they are often mistaken for each other. However, many women may have
both. Women with endometriosis frequently have abdominal and bowel symptoms
and these symptoms may be attributed to IBS, a "spastic colon," or to actual
intestinal involvement from endometriosis.

Endometriosis implants may be found on or in the bowel wall. How common is
this? Reports of the incidence of intestinal involvement of endometriosis range
from 3 to 34%; conservative estimates range from 5 to 10%. The hallmark of the
diagnosis of intestinal endometriosis is that a woman has significant GI symptoms
that vary with her menstrual cycle. The symptoms may be present only at the
time of the menstrual period or they may be present all month long and worsen
at the time of the period. The most common symptoms include loss of appetite,
nausea (vomiting is rare), diarrhea, increased gas, significant bloating, crampy
abdominal pain, painful bowel movements, and sharp stabbing rectal pain. Many
women also complain of constipation that seems to vary with the menstrual cycle.
Unexplained iron-deficiency anemia may also be a clue to the presence of intestinal
endometriosis. Another clue is rectal bleeding that is associated with menstruation.

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